The Canadian Elevator Industry. Welfare and Pension Plans. Member Booklet

Transcription

1 The Canadian Elevator Industry Welfare and Pension Plans Member Booklet DISCLAIMER Every attempt is made to keep information up-to-date and accurate, however, there may be changes to your plan terms that are not reflected in the latest published plan booklet available on this site. Manion Wilkins therefore makes no warranty, guarantee, or promise, express or implied, concerning the content of the benefit plan booklet. In addition, a new release of the booklet, reflecting changes in your coverage, may be uploaded in this site at any time and without prior notification to plan members. You should contact the plan administrator for confirmation of benefit levels and coverage before relying on the information posted here.

2 TO MEMBERS OF THE CANADIAN ELEVATOR INDUSTRY WELFARE AND PENSION PLANS The Welfare Plan was established in 1952 and the Pension Plan was established on October 1, Since then due to the sound financial condition of the Trust Funds the Trustees have been able to extend and improve the benefits under both Plans from time to time. The Plans are fully portable within the Industry which means that you do not lose pension credits and you remain eligible for Welfare Plan benefits if you change employment, provided that you remain employed within the scope of the Collective Agreements between the International Union of Elevator Constructors and the Employers. A Board of Trustees representing the parties concerned is responsible for the management of each Plan. The Boards are made up of the following members: THE BOARD OF TRUSTEES Mike Conkin Gordon Heard Ben McIntyre WELFARE PLAN David McColl Andrew Reistetter Kevin Lavallee Mike Conkin Gordon Heard Ben McIntyre PENSION PLAN David McColl Andrew Reistetter Kevin Lavallee The Trustees have appointed a Plan Administrator, Manion, Wilkins & Associates Ltd., to look after the day-to-day administration of the Plans subject to the guidance and control of the Trustees. The Plan Administrator maintains records of contributions and is responsible for all procedures necessary to operate the Plans. The latest changes to the Plans as of January 1, 2010 are included in this booklet and you will be informed of any future amendments through Newsletters and postings on the Website. If you have any questions regarding your benefits under the Plans, please communicate with the Plan Administrator. i

3 Addresses and telephone numbers are: For Welfare Benefits: For Pension Benefits: Manion, Wilkins & Associates Ltd. Manion, Wilkins & Associates Ltd Four Seasons Place Pension Department Etobicoke, Ontario M9B 0A5 222 Rowntree Dairy Road, 3 rd Floor Woodbridge, Ontario L4L 9T Toll Free Fax Toll Free Fax Contact Centre: Toll Free Fax [email protected] Website: Website: READ THIS BOOKLET CAREFULLY, BUT REMEMBER This booklet is a general outline of the Plans and its purpose is to explain as briefly and clearly as possible each of the benefits to which you are entitled. The benefits outlined under the Plans are subject to the terms and conditions of the Plan documents and Group Master Policies. If there is any conflict between this outline and the Plan documents and Group Master Policies, the Plan documents and Group Master Policies will apply in all cases. Also remember that no benefits are guaranteed and that the benefits can be changed by the Trustees at any time. ii

4 TABLE OF CONTENTS Page 1 Notice Regarding Personal Information... 1 Welfare and Pension Plans 1 Definitions Eligibility Enrolment Contributions... 6 Welfare Plan 1. Benefit Highlights Eligible Dependents Description of Benefits (a) Life Insurance (b) Accidental Death and Dismemberment Benefits (c) Weekly Indemnity (d) Long Term Disability (e) Major Medical Benefits (Employees and Dependents) (f) Dental Benefits (Employees and Dependents) (g) Member and Family Assistance Program General Exclusions Coordination of Benefits General Information Pay-Direct Coverage Extension of Major Medical and Dental Benefits on an Employee s Death Extension of Major Medical and Dental Benefits if Sick or Disabled No Break in Service Arrangement Designation of Beneficiary iii

5 Welfare Plan (Cont d) 12. Benefits Pertaining to Pensioners Terminated Former Employees How to Submit Claims Termination of Welfare Coverage Future of the Plan Pension Plan 1. Retirement Dates Credited Service Amount of Pension Pension Benefits at or After Death of a Retired Member Additional Supplementary Benefit Application for, and Payment of, Pensions Break in Service No Break in Service Arrangement Death Benefits Before Retirement Termination Benefits Employment of a Pensioner Designation of Beneficiary General Provisions Termination of Pension Coverage Appendix A Appendix B iv

6 NOTICE REGARDING PERSONAL INFORMATION When you apply for coverage Manion, Wilkins & Associates Ltd. (the Plan Administrator) sets up a file, or series of files, with personal information relative to your Pension and/or Health Benefits under the Plan. This includes all of the information concerning your enrolment, your benefits and your claims. The purpose of this file is to permit the Plan Administrator to administer your benefits under the Plan. This includes the following: Arranging insurance coverage where applicable Claims adjudication, management and payment Internal and external audits Income tax reporting purposes where applicable Preparation of reports used by the plan sponsor (Board of Trustees) in the financial management of the Plan Administering your pension benefits Your file will be kept in the offices of the Plan Administrator. Your personal information is used by the Plan Administrator and shared, only to the extent required by law, with your plan sponsor, your Local Union, and the coverage provider(s) and financial institutions involved in caring for your plan(s). Only authorized persons have access to your file when required for coverage purposes. The information in your file is securely stored and is not shared with any other parties, unless you authorize us to release it to them, or the disclosure is required by law. You have the right to access the personal information in your file and, if necessary, have it corrected by submitting a written request to the Plan Administrator. 1

7 WELFARE AND PENSION PLANS ELIGIBILITY, ENROLMENT and CONTRIBUTIONS The following terms are used in this booklet as defined in this Section. 1. DEFINITIONS ACUPUNCTURIST, ATHLETIC THERAPIST, CHIROPODIST, CHIROPRACTOR, DENTIST, DENTURIST, MASSAGE THERAPIST, NATUROPATH, OPTOMETRIST, OSTEOPATH, ORAL SURGEON, ORTHODONTIST, PHARMACIST, PODIATRIST mean duly qualified individuals legally licensed and/or registered to practice in their respective disciplines. CALENDAR YEAR means January 1 to December 31 of any one year. CONTINUOUS SERVICE means the total number of years (part years will be calculated on the basis of completed months expressed as 12ths of a year) in a relevant period during which an Employee has been a member of the Welfare Plan from the Employee's latest date of participation in the Welfare Plan to the Employee's next following date of: (1) termination from covered employment in the Canadian Elevator Industry, or (2) retirement from active employment in the Elevator Industry under the Pension Plan. CONVALESCENT HOSPITAL means an extended-care facility, such as a sanatorium or skilled nursing home, or a special wing or ward of a Hospital. EMPLOYEE includes any mechanic or helper who is an active member in good standing with the International Union of Elevator Constructors in Canada and is employed within the scope of the Collective Agreements, a retired member of the International Union of Elevator Constructors who retired on pension directly from active covered employment in the Industry, and any Employee who has accepted a supervisory position and who has opted to remain an active member in good standing with the International Union of Elevator Constructors and has opted to remain in the Welfare Plan after the date of promotion. 2

8 HOME HEALTH AIDE means a person legally licensed to provide skilled nursing or other therapeutic services through a home health agency. HOSPITAL means an institution which chiefly provides inpatient medical care of the injured, sick or chronically ill, has a staff of licensed doctors (M.D.) and 24-hours nursing care by registered nurses (R.N.), and is approved as a hospital for payment of the ward rate under the Provincial Health Plan. PHYSICIAN means a duly qualified physician or surgeon who is legally licensed to practice medicine. PLAN ADMINISTRATOR means: Manion, Wilkins & Associates Ltd Four Seasons Place Etobicoke, Ontario M9B 0A5 PSYCHOLOGIST means a duly qualified individual legally licensed to provide therapeutic services in the treatment of mental and emotional illnesses within the scope of his or her license. REASONABLE AND CUSTOMARY means the usual charge of the provider for the service or supply, in the absence of coverage, but not more than the prevailing charge in the area for a like service or supply. A like service or supply is one of the same nature and duration, requires the same skill and is performed by a provider of similar training and experience. SERVICE means the total number of years for all periods of an Employee's participation under the Welfare Plan. SPOUSE means a person who - (a) is legally married to the Employee and is not living separate and apart from the Employee; or (b) although not married to the Employee, is and has been living with the Employee in a conjugal relationship either: i. continuously for at least one year; or ii. in a relationship of some permanence, if they are the natural or adoptive parents of a child, both as defined in the Family Law Act of Ontario. 3

9 Notes: (1) A notarized statement confirming the status of any common-law relationship must be provided to the Plan Administrator. (2) For purposes of the Pension Plan the definition of "Spouse" shall be as required under the pension legislation for the province in which you are employed. If you require the definition which applies to you, please contact the office of the Plan Administrator. 2. ELIGIBILITY (a) All Employees: All Employees who are employed within the scope of the Collective Agreements between the International Union of Elevator Constructors and the Employer and who are in good standing with the International Union of Elevator Constructors must join both the Welfare Plan and the Pension Plan. (b) New Employees: New Employees are enrolled in the Plans on the day on which they become eligible for coverage within the scope of the Collective Agreements. Employee and Employer contributions become payable from that date. New Employees are not eligible for coverage under the Welfare Plan until they have: (1) completed the probationary period of six months as set out in the Collective Agreements; and (2) accumulated and contributed, and had contributions made to the Welfare Plan on their behalf by their Employer, for a further 900 hours following completion of the probationary period. Note: During this 900-hour accumulation period such employee is eligible for the Major Medical and Dental Benefits provided under the Welfare Plan. Full coverage will be provided once the employee meets all conditions outlined in this item (2). Note: This requirement does not apply to coverage under the Pension Plan which becomes effective as soon as contributions are received on behalf of the Employee. 4

10 (c) Partners and Sole Proprietors: Employees who are partners or sole proprietors of an incorporated company by which they are employed are eligible to participate in the Plans. Contributions for a minimum of 160 hours per month must be remitted to be eligible for Welfare Plan participation. In addition to this monthly contribution partners and sole proprietors must contribute and maintain a 3-month advance contribution to be eligible for Welfare participation. When applying for coverage Articles of Incorporation must be submitted to the Trustees. Contributions to the Pension Plan are based on the actual hours worked in the month. If the company is not incorporated, the employee is not eligible to participate in the Welfare and Pension Plans. (d) Employees Promoted to Supervision: Employees who have accepted a supervisory position and who remain active members in good standing with the International Union of Elevator Constructors have the option of either: (1) remaining in the Plans for service after the date of promotion, subject to the approval of the Employer, the International Union of Elevator Constructors and the Trustees; or (2) terminating their active membership in the Plans for service after the date of promotion by notification to the Trustees. 3. ENROLMENT When you become eligible for coverage under the Plans, you are required to complete and sign enrolment cards for both the Welfare Plan and Pension Plan. These cards are available at your Local Union Office. Your coverage under the Welfare Plan cannot begin until a Welfare Plan Member Information Card is received by the Plan Administrator. Advise the Plan Administrator of all changes to your status. You must file a Member Information Change Form if any of the following occur: a) Marital status and/or name change b) Addition or deletion of dependents c) Beneficiary update 5

11 d) Spouse update e) Address change* f) Changes to your Spouse s insurance g) if you receive a document from the Plan Administrator and you notice an error in any of your information, such as your date of birth or name * Address changes can also be made through your Local Union Office by letter or phone upon full identification. 4. CONTRIBUTIONS Each Employer is obligated to remit contributions to both Plans, in accordance with the Collective Agreement, in respect of all its eligible Employees. Deductions must be made from the remuneration of such Employees so that both Employer and Employee contributions may be made to the Plans. Deductions for overtime hours are made on an hours worked basis. To make these deductions, your Employer and the International Union of Elevator Constructors must have on file a signed blue "Deduction Authorization" form which you should obtain from your Local Union Office. No contributions are required for paid holidays covered by the Collective Agreements or vacation periods of less than 30 days. 6

12 WELFARE PLAN The Welfare Plan was designed to provide you and your eligible dependents with health and welfare protection. You, as the member, will be reimbursed for specific medical, health and dental costs which you have incurred. In addition, the Plan provides you with life, accidental death and dismemberment, and disability insurance. The various benefits are described in full in Section 3 of this booklet. 1. BENEFIT HIGHLIGHTS (a) LIFE INSURANCE EMPLOYEES ONLY Amount $80,000. This benefit terminates when you retire or reach age 70, whichever is earlier. (b) ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS EMPLOYEES ONLY Amount $80,000. This benefit terminates when you retire or reach age 70, whichever is earlier. (c) WEEKLY INDEMNITY BENEFIT FOR ACTIVE EMPLOYEES Weekly Benefit $500 (d) LONG TERM DISABILITY BENEFIT FOR ACTIVE EMPLOYEES Monthly Benefit $2,750. This benefit terminates when you retire or reach age 65, whichever is earlier. 7

13 (e) MAJOR MEDICAL BENEFITS FOR EMPLOYEES AND DEPENDENTS a. Overall Maximum $25,000 per covered person s lifetime. When this maximum is reached, each covered person will be reimbursed up to a maximum of $5,000 per year thereafter. Note: These maximums do not apply to the Prescription Drug or the Vision Care benefits. b. Eligible Expenses Maximum Amount Payable (per covered person) Services of a Psychologist Services of a Chiropractor, Acupuncturist, Naturopath, Massage Therapist, Athletic Therapist, Osteopath, Physiotherapist, or Speech Therapist Services of a Podiatrist or Chiropodist Wheelchairs Elastic Support Stockings Orthopedic Shoes or Orthotics Hearing Aids $45 per treatment, not to exceed 50 treatments in a calendar year $45 per treatment, not to exceed 15 treatments in a calendar year per practitioner $45 per treatment, not to exceed a combined maximum of 15 treatments in a calendar year $2,000 per lifetime $100 in a calendar year A total maximum of one pair in a calendar year $600 per lifetime 8

14 Vision Care - Lenses and frames for eyeglasses, contact lenses or laser eye surgery - Contact Lenses, when vision cannot be improved to at least 20/40 level by eyeglasses $300 every two calendar years ($300 each calendar year for eyeglasses for dependent children under age 14) Note: If a covered person has laser eye surgery, he or she may submit his or her laser eye surgery claim every two calendar years and he or she will receive up to the maximum amount payable under the Plan until the total charge for the laser eye surgery has been paid. $550 every 5 calendar years - Eye examinations $80 every two calendar years (f) DENTAL BENEFITS FOR EMPLOYEES AND DEPENDENTS a. Dental Fee Guide The 2006 Ontario Dental Association Fee Guide applies in all provinces b. Maximum for Crowns, Dental Implants, Bridges, Dentures and Orthodontic Services $2,000 per covered person per calendar year (g) MEMBER AND FAMILY ASSISTANCE PROGRAM (MFAP) The Member and Family Assistance Program (MFAP) provides confidential, professional counselling for a broad range of personal and family problems as well as a full suite of additional health and wellness tools and services. 9

15 2. ELIGIBLE DEPENDENTS Eligible dependents are your Spouse and your natural unmarried dependent children under 19 years of age who are not themselves eligible for coverage under the Welfare Plan as Employees. Dependent children 19 years of age and over who continue their education on a full time basis at an accredited school may be covered under the Welfare Plan until they reach age 25 provided they are not otherwise employed on a full time basis. Proof of their full time attendance at school must be submitted to the Plan Administrator on an annual basis. Dependent children who are over the age of 19 and for medical reasons are totally dependent on you for support may be covered under the Welfare Plan provided they are not otherwise covered as an employee under their own benefit plan. In order for a child to have coverage under this provision you must submit documentation to the Trustees for approval. Note: Children who are not the member s natural children are not covered unless the member legally adopts them. 3. DESCRIPTION OF BENEFITS (a) Life Insurance (Employees Only) Your $80,000 of Life Insurance is paid to your designated beneficiary upon your death from any cause whatsoever while you are covered under the Plan. Conversion Privilege - If your employment in the Industry terminates or you retire, your Life Insurance is continued without cost for thirty-one days. During this time, you have the privilege of applying, without a medical examination, for an individual policy on any one of the standard plans issued by the life insurance company, except a policy with a disability or double indemnity benefit or a term insurance policy. The amount of such individual policy shall not exceed the amount for which you were insured under the Group Policy. Regular individual premiums will apply and the individual policy will become effective thirty-one days after your termination of employment or retirement. 10

16 (b) Accidental Death and Dismemberment Benefits (Employees Only) If death, dismemberment or loss of sight occurs because of injury due to an accident, and within 365 days of the accident, you will receive: For loss of : - Life (paid to your designated beneficiary)... $80,000 - Both hands or both feet... $80,000 - Sight of both eyes... $80,000 - One hand & one foot... $80,000 - One hand and sight of one eye... $80,000 - One foot and sight of one eye... $80,000 - One arm or one leg... $60,000 - One hand or one foot... $53,333 - Sight of one eye... $53,333 - Thumb and index finger or at least two fingers of one hand... $26,667 - Speech and hearing in both ears... $80,000 - Speech or hearing in both ears... $60,000 - Hearing in one ear... $13,333 - All the toes of one foot... $10,000 - Use of both arms or both hands... $80,000 - Use of both feet or both legs... $80,000 - Use of one hand... $80,000 - Use of one arm or one leg... $60,000 - Use of one foot... $53,333 For quadriplegia, paraplegia or hemiplegia... $160,000 If your loss is sustained in an automobile accident, provided you were wearing a seat belt at the time of the accident, you will receive an additional 10% of the benefit otherwise payable. If more than one loss is sustained as the result of the same accident, payment will only be made for one loss, the greatest. Note: The following are not covered: (1) suicide or self-destruction or any attempt thereat; (2) declared or undeclared war or any act thereof; (3) active full-time service in any armed forces; (4) flight in any aircraft, except as a passenger. 11

17 (c) Weekly Indemnity Eligibility All Active Employees This benefit provides eligible members with a weekly income provided they are totally disabled due to a non-occupational injury or disease. To qualify for the Weekly Indemnity (WI), you must satisfy the following: You were actively at work on the date your disability commenced. If you become totally disabled, you must apply to Employment Insurance (EI) for sickness benefits. If you meet the EI eligibility requirements, you will receive up to a maximum of fifteen (15) weeks of benefit payments from EI, OR If you are totally disabled, you must be eligible to receive payments from another weekly indemnity plan that is provided through your Local up to a maximum of 17 weeks (includes the 2-week EI waiting period). Commencement of Benefits Benefits commence after 17 weeks if you qualify for the maximum of 15 weeks of benefit payments from EI. If you do not qualify for the maximum of 15 weeks from EI, benefits will commence when EI benefits are no longer payable. If you do not qualify for any EI benefits, Weekly Indemnity benefits commence after 14 days of disability. If you receive benefit payments from another weekly indemnity plan provided through your Local, your benefit payments under this Plan commence after 17 weeks. Amount of Weekly Benefit The Weekly Indemnity benefit is $ Weekly Indemnity benefits are non-taxable. 12

18 Benefit Duration Weekly Indemnity benefits commence after the termination of EI disability benefits and are payable up to your 53 rd week of disability. WI benefits are not payable after the date you retire. Application To apply for WI benefits, you will be required to submit a fully completed WI claim form and your EI benefit statement to the Plan Administrator. If you are not eligible for disability benefits from EI, or your disability benefits are terminated by EI prior to receiving 15 weeks of payments, you must submit proof to the Plan Administrator indicating the date of your last payment or that you are not eligible for disability benefits through EI. Recurring Disability If a member who was receiving WI benefits becomes disabled as a result of the same or related cause(s) within 30 days after returning to active work, the member will be considered disabled for one continuous period and no waiting period will be applied. If a member has returned to active work for one full day and becomes disabled from different or unrelated causes, the member will begin a new period of disability and the waiting period shall be applied. Exceptions and Limitations No benefits are payable for: (1) Any portion of a period of disability unless you are receiving ongoing supervision/treatment by a physician deemed appropriate for the impairment which is causing the disability. You will not be paid for any portion of a period of disability during which you do not participate in the treatment program recommended by said physician. (2) Any portion of a period of disability during which you are receiving treatment by a therapist unless such treatment is recommended by a physician deemed appropriate. 13

19 (3) Any portion of a period of disability resulting from substance abuse, including alcoholism and drug addiction, unless you are participating in a recognized substance withdrawal program. (4) Disabilities resulting from self-inflicted injuries or attempted suicide. (5) Disabilities as a result of participation in a war, riot, insurrection or criminal act. (6) Disabilities resulting from an accident which occurs while you are operating a motor vehicle and the blood contains more than 80 milligrams of alcohol in 100 millilitres of blood (.08%). (7) The portion of a period of disability during which you are i. imprisoned in a penal institution, or ii. confined in a hospital, or similar institution, as a result of criminal proceedings. (8) Disabilities which commence on or after the date a strike or layoff begins. (9) Disabilities which occur while performing any occupation or employment for remuneration or profit. (10) Disabilities for which you receive benefits in accordance with the provisions of a Workers Compensation Board/Workers Safety Insurance Board or similar law. Reimbursement (Recovery of Benefits) If you received WI benefits under this Plan and you recover monies from a third party (by way of judgement or settlement) for the same disability, or as a result of the incident which caused or contributed to your disability, then such recovered monies must be paid to the Trust Funds up to the total WI benefits received by you. You will be required to execute documents which acknowledge that you understand your obligation to reimburse and to assign monies you recover to the Trust Funds up to the total amount of WI benefits received for the same period of disability. 14

20 (d) Long Term Disability Eligibility All Active Employees This benefit provides eligible members with a monthly income provided they are totally disabled and meet all of the eligibility requirements. You must be totally disabled (as defined below) prior to age 65. You must be under the continued treatment of a legally qualified physician, deemed appropriate by the insurer, provided: you were actively at work on the date your disability commenced; and written proof of total disability is provided. Qualifying Disability Period The qualifying disability period starts when you first become totally disabled and ends after 52 weeks, provided your disability is continuous and you are under age 65. If the disability is not continuous, the days you are disabled will be accumulated to satisfy the qualifying disability period provided: (1) no interruption is longer than 2 weeks; (2) the disabilities arise from the same or related disease or injury. Commencement of Benefits Benefits commence after 52 weeks of continuous disability. Amount of Monthly Benefit The Long Term Disability benefit of $2, per month is payable at the end of the month. Long Term Disability benefits are taxable. Maximum Benefit Period Benefits will cease on the earlier of: recovery (you no longer meet the definition of Total Disability ); end of the month in which you attain age 65; or the date you are eligible for a full (unreduced) pension. 15

21 Benefits may be payable after you attain age 65 if you satisfied the Qualifying Disability Period while age 64, in which case the maximum benefit period shall be 12 consecutive months. In no event shall benefits be payable after your death, recovery, or attainment of age 66. Total Disability Definition For the first 36 consecutive months of benefit payments, Total Disability shall mean the disabled member is not able to perform any and every duty of the member s occupation or employment. After 36 months of benefit payment, Total Disability shall mean the disabled member is not able to perform any and every duty of any occupation or employment for which the member is reasonably qualified by education, training, or experience. Such incapacity must result from a medically determinable physical or mental impairment. Recurring Disability If a member who was receiving Long Term Disability benefits becomes disabled from the same or related cause(s) within 30 days after returning to active work, the member will be considered disabled for one continuous period and no waiting period will be applied. If a member has returned to active work for one full day and becomes disabled from different or unrelated causes, the member will begin a new period of disability and the waiting period shall be applied. Reductions The amount payable under this benefit for total disability is reduced by any other sources of income. These include the following: (1) Wages or retirement benefits payable from any employer and/or the Canadian Elevator Industry Pension Trust Fund, other than for rehabilitation. (2) Any payments on account of your disability from any Workers Compensation Board/Workers Safety Insurance Board, or similar law (except benefits received for any unrelated disability). (3) Payments received from the Canada or Quebec Pension Plan primary benefits only. (Primary benefits exclude any amounts payable for dependents.) 16

22 (4) Any income or benefit payable under any other plan or program of any government or the Crown or of any subdivision or agency of the government or the Crown, including any plan or program established pursuant to a provincial automobile insurance act. (5) 50% of any earnings received from employment under any rehabilitation program. (6) 50% of any income from a different and lesser paid occupation not related to the rehabilitation program described below, assuming the disabled member is still eligible for Long Term Disability benefits. You must apply for all benefits or income for which you may be, or may become, eligible under any of the preceding sources. All Source Maximum A member s total monthly income while disabled cannot exceed 75% of gross monthly earnings as of the date disability commences. If a member s total monthly income exceeds 75%, Long Term Disability benefits will be reduced accordingly. With respect to a disabled member participating in a Rehabilitation Program, total monthly income while disabled cannot exceed 100% of gross monthly earnings as of the date disability commences. If total income exceeds 100%, the Long Term Disability Income benefit will be reduced by the amount of such excess. Benefits During Rehabilitation Program The insurer may recommend that a program of rehabilitation is appropriate for a member currently in receipt of Long Term Disability Benefits. The insurer will notify the member in writing of its approval of the program and the extent, if any, of its support during such program. Any of the following may be eligible for consideration as a rehabilitation program: the member s regular occupation on a part-time basis; a formal vocational program; or any other training program deemed suitable by the insurer. Long Term Disability benefits will continue to be payable to a member participating in a rehabilitation program approved by the insurer for up to 24 consecutive months. 17

23 Reasonable and customary expenses incurred by the member in connection with the program will be reimbursed by the insurer provided the member has received prior approval from the insurer. The insurer will not reimburse expenses payable through any government program or a third party insurer. The gross benefit less the reductions identified above will be further reduced by 50% of any earnings received from employment under the rehabilitation program subject to the All Source Maximum. A member s involvement in a rehabilitation program will cease on the earliest of the following: the date the member ceases to be Totally Disabled ; the date the member completes the rehabilitation program; or the date the insurer determines that the member is not participating in the rehabilitation program to the extent previously agreed upon by the member and the Insurer. Note: No benefit shall be payable to an insured individual who refuses to participate in a program of rehabilitation which is deemed appropriate by the insurer. Reimbursement (Recovery of Benefits) If you are entitled to recover compensation for loss of income from a third party as a result of the incident which caused or contributed to the disability, for which benefits are paid or payable, the insurer will be subrogated to all your rights of recovery for loss of income, to the extent of the sum of benefits paid or payable by the insurer. You shall execute such documents as required. In the event that you provide proof that you have not recovered full compensation for loss of income, the insurer shall determine the proportion of damages actually recovered and share pro rata in that amount. Should you choose to settle the matter prior to judicial determination, it is understood that the sum reached in settlement will be deemed to be full compensation for loss of income, and the insurer s right of subrogation will apply. The term compensation shall include any lump sum or periodic payments which you receive or are entitled to receive on account of past, present or future loss of income. 18

24 Exclusions and Limitations Benefits are not payable for the following: (1) Any portion of a period of disability unless you are receiving ongoing supervision/treatment by a physician deemed appropriate for the impairment which is causing the disability. You will not be paid for any portion of a period of disability during which you do not participate in the treatment program recommended by said physician. (2) Any portion of a period of disability during which you are receiving treatment by a therapist unless such treatment is recommended by a physician deemed appropriate. (3) Any portion of a period of disability resulting from substance abuse, including alcoholism and drug addiction, unless you are participating in a recognized substance withdrawal program. (4) Disabilities resulting from self-inflicted injuries or attempted suicide. (5) Any period of disability, or portion thereof, during any leave of absence (including maternity leave) as defined below: Leave of Absence shall mean a period of time away from work mutually agreed by you and your employer. In the case of maternity leave of absence, the leave shall begin and finish on dates agreed to by you and your employer or as required by Provincial or Federal law. (6) Disabilities as a result of participation in a war, riot, insurrection or criminal act. (7) Disabilities resulting from an accident which occurs while you are operating a motor vehicle and the blood contains more than 80 milligrams of alcohol in 100 millilitres of blood (.08%). (8) The portion of a period of disability during which you are i. imprisoned in a penal institution, or ii. confined in a hospital, or similar institution, as a result of criminal proceedings. (9) Disabilities which commence on or after the date a strike or layoff begins. 19

25 (10) Any disability resulting from injury or disease which occurred while you were on active duty in the armed forces of any country, state or international organization. Canadian Residency Requirement No benefits are payable if the member resides outside Canada for any period exceeding 90 consecutive days or a total of 180 days in any 365 day period, unless: (1) the member has previously notified and received approval in writing from the Insurer, and; (2) the member remains under the regular care of a licensed physician deemed appropriate by the Insurer, and; (3) proof of the ongoing disability can be determined on evidence satisfactory to the Insurer in English or French within 30 days of request. (e) Major Medical Benefits (Employees and Dependents) The specified Major Medical expenses are payable provided they are reasonable and customary, needed for medical care and provided they are not covered by your Provincial Medicare Plan up to Overall Lifetime Maximum of $25,000 per covered person. When this maximum is reached, each covered person will be reimbursed up to a maximum of $5,000 per year thereafter. Note: these maximums do not apply to the Prescription Drug or Vision Care benefits The following expenses are covered at 100%, except as noted otherwise: (1) Prescription Drug Benefits Reasonable and customary charges incurred for medically necessary drugs and medicines specified below. Such drugs and medicines must be obtained only by prescription from a person entitled by law to prescribe them and dispensed by a licensed pharmacist, physician or other health care practitioner authorized by provincial legislation to dispense them. 20

26 No benefit shall be payable for any single purchase of drugs which would not reasonably be used within 90 days from the date of purchase. (a) Eligible Drug Expenses: Includes: All generic drugs and life sustaining medications Diabetic supplies such as needles, syringes, test strips, lancets and solutions For retired members age 65 years and older, prescription drug costs in excess of that paid by a provincial drug plan, including any required annual premiums Smoking cessation products will be reimbursed at 75% up to a maximum of $500 per calendar year Erectile dysfunction drugs up to the maximum of $1,000 per calendar year (b) Ingredient Cost: For drugs listed in the provincial Drug Benefit Formulary and Limited Use Drugs the ingredient cost will be limited to the current Formulary price plus a mark-up. For all other drugs the ingredient cost will be limited to the pricing followed by the major drug wholesaler in the applicable province, plus a mark-up. (c) Dispensing Fee: There is a dispensing fee maximum eligible expense of $7.50 per prescription. Maintenance drugs are limited to one dispensing fee for each 90-day supply. Drug compounds, solutions, creams and mixtures will be reimbursed to a maximum of $30 for the professional fee. A drug compound is a special medication made from a mixture of drugs. (d) Prescription Drug Exclusions: Over the counter medications or drugs for which a prescription is not required by law (federal or provincial) Fertility drugs or drugs to promote abortion 21

27 Drugs which are not considered medically necessary, e.g. cosmetic or weight loss/lifestyle, unless they are approved under the ESI Canada Inc. Prescription Drug Plan Prior Authorization Procedure Vitamins (injectable or oral) unless they legally require a prescription Alcohol swabs Medication which is provided and administered by a health care practitioner (unless they legally require a prescription) Hospital Funded/Administered drugs are not covered by the Welfare Plan HIV/AIDS medications Contraceptive devices and birth control pills (e) Prior Authorization Prior Authorization of medically prescribed drugs will be required for any drug that has multiple indications and/or new drugs entering the market after January 1, A prior authorization will be required to ensure that the drug is being administered for medical purposes only, prior to the payment of the drug. Prior Authorization will also be required for new drugs entering the market by having the covered person s health care practitioner confirm that this new more costly drug is necessary over the current medications being prescribed. The Prior Authorization will be needed before new drugs are paid for by the Welfare Plan. (f) Maintenance Drugs These are drugs which you or your eligible dependent have been taking for at least 6 months and which you or your dependent are required to take for a long period of time for a particular condition. Some examples of maintenance medications include blood pressure medication, heart medication, thyroid pills. Note: The Welfare Plan will only cover one dispensing fee every 90 days for maintenance medication. 22

28 (g) Generic Drugs If there is a generic substitute for the drug the covered person has been prescribed, the Welfare Plan will reimburse only up to the cost of the lowest priced generic equivalents regardless of whether the brand name or the generic equivalent is purchased. If, for any reason, the covered person s health care practitioner insists the covered person receive a certain brand name medication, the words no substitution must be included on the prescription. The covered person will be reimbursed based on the cost of the brand name drug upon proof that the covered person s health care practitioner as specified no substitution. (h) Important Note: If You (Or Your Spouse) Are Age 65 or Over: For residents of all provinces, other than Nova Scotia Any portion of a claim not covered by the covered person s provincial plan may be paid through this Plan s prescription drug benefits in conjunction with the Canadian Elevator Industry Welfare Plan rules. In provinces where a premium payment is required to continue your provincial health plan coverage, the Canadian Elevator Industry Welfare Plan will reimburse you the cost of the provincial drug plan premium after you submit your paid receipt for reimbursement. For residents of Nova Scotia In Nova Scotia, a private plan is the first payor, so the Canadian Elevator Industry Welfare Plan will cover the eligible drug expenses. Any premium payment required to continue a covered person s provincial health plan coverage will not be reimbursed under this Plan. (2) Charges for Standard Hospital accommodation (room and board only) for an unlimited period if not covered by a provincial health plan. (3) Charges by professional ambulance services for transportation to and from a Hospital for confinement. 23

29 (4) Charges for services provided upon the prescription of a Physician by a Convalescent Hospital to which the patient is transferred after confinement as a Hospital bed-patient for at least three days (but not for rehabilitation or custodial care). (5) Charges for the following services or supplies prescribed by a Physician unless provided by the hospital or other institution: (a) Oxygen and its administration. (b) Blood transfusions including the cost of the blood. (c) Services of registered graduate nurses, licensed practical nurses or registered nursing assistants (other than members of your family or the staff of the Hospital or Convalescent Hospital). Note: Nursing services provided in the Hospital are not covered. (d) (e) (f) Rental or purchase of wheelchairs up to a $2,000 lifetime maximum. Rental of hospital beds, iron lungs or intermittent positivepressure breathing machines. (Individual consideration may be given by the Trustees to the purchase rather than rental of eligible equipment, as well as to the expenses incurred in its repair or adjustment.) Splints, trusses, braces, orthopedic back supports, crutches, casts, artificial limbs and eyes and hair prosthesis. (g) Elastic support stockings purchased from a recognized surgical supply house up to a maximum of $100 in a calendar year. To be eligible, elastic support stockings must be recommended by a licensed doctor (M.D.) or podiatrist, provided the stockings a compression value of at least 20 to 30 mmhg pressure and are required to treat a diagnosed medical condition as determined by the Plan Administrator. (h) (i) Insulin infusion pump (one per lifetime), payable at 50% of the eligible expense. Orthopedic shoes which are an integral part of a brace or which are specially constructed for the patient, any modifications to such shoes, or orthotics, but not to exceed more than one pair in a calendar year. 24

30 To be covered under the plan, orthopedic shoes and orthotics must be recommended by a licensed doctor (M.D.), podiatrist or chiropodist, custom made and specifically designed and molded for the covered person, dispensed by a certified podiatrist, chiropodist, pedorthist or orthotist and required to correct a diagnosed physical impairment. Recommendation must include the diagnosis, symptoms and chief complaints. No benefit will be provided if the orthopedic shoes or orthotics are prescribed or dispensed by a practitioner other than those listed above. To avoid misinterpretation of what is eligible and what may or may not qualify as a covered expense, you must submit an estimate to the Plan Administrator for confirmation prior to the purchase. (j) (k) (l) Hearing aids obtained on the written prescription of a Physician certified as an audiologist up to a $600 lifetime maximum. Services of a registered clinical psychologist up to a maximum of $45 per treatment, but not exceeding 50 treatments in a calendar year. Services of duly qualified speech therapists up to a maximum of $45 per treatment, but not exceeding 15 treatments in a calendar year. (m) Charges for services of a legally licensed and duly qualified Physiotherapist, Massage Therapist or Athletic Therapist where all or a portion of such treatment is not covered by a government plan up to a maximum of $45 per treatment, but not exceeding 15 treatments in a calendar year, per type of practitioner. (n) Charges for the services of a legally licensed and duly qualified Chiropractor, Naturopath, Osteopath, or Chiropodist/Podiatrist up to a maximum of $45 per treatment, but not exceeding 15 treatments in a calendar year, per type of practitioner. Note: These benefits are only payable after the yearly maximum, if any, has been received from your Provincial Government Plan. X-rays, medicines, drugs, or dressings ordered by one of the above are not covered under the Welfare Plan. 25

31 Claims for reimbursement for the above must be accompanied by the written prescription from your Physician and a letter from your Physician setting out the diagnosis of the condition which requires the services or supplies. (o) Charges incurred for acupuncture for the treatment of sickness or injury, where all or a portion of such treatment is not covered by a Government Plan up to a maximum of $45 per treatment, but not exceeding 15 treatments in a calendar year. Note: In no event shall acupuncture treatment be covered if used as a remedy for smoking, alcohol abuse, diet control or other addiction problems. (6) With approval of the Trustees, reasonable charges for the services provided by a Home Health Agency under the care and direction of a Physician on a visiting basis in the patient s home, unless coverage is available under a provincial medical plan. Note: Homemaker services are not covered. (7) Vision Care (a) (b) (c) Purchase, repair or replacement of lenses and frames for eyeglasses or contact lenses, or laser eye surgery, prescribed by a Physician or Optometrist up to a maximum of $300 every two calendar years. Eyeglasses purchased (or repaired) for dependent children under age 14 at the date of purchase will be payable up to a maximum of $300 each calendar year. In addition, if visual acuity of 20/40 cannot be achieved by eyeglasses and this is confirmed in writing by your Physician or Optometrist, a maximum of $550 is payable during the fifth calendar year following the year in which the last purchase was made towards the purchase of contact lenses prescribed by a Physician or Optometrist for severe corneal astigmatism or scarring. If written confirmation cannot be obtained from your Physician or Optometrist, your contact lenses will be covered in accordance with the coverage for eyeglasses in (a) above. Charges for eye examinations, if not covered by a provincial health plan, up to a maximum of $80 every 2 calendar years. 26

32 (f) Dental Benefits (Employees and Dependents) The following dental services or supplies are payable in accordance with the Dental Schedule of Fees adopted by the Trustees. The 2006 Ontario Dental Association Fee Guide applies in all provinces. (1) 100% of fees allowed in the adopted Dental Fee Guide for the following services. (a) Diagnostic services limited to: i. prophylaxis, including scaling and polishing teeth once every 6* months; ii. full-mouth series of X-rays once every 12* months; iii. oral examinations (full exam once every 24* months). *Note: Once every 6, 12 or 24 months means once during the period from the date on which a service is provided or a purchase is made until the same day 6, 12 or 24 months thereafter. (b) Amalgam, silicate and acrylic fillings. (c) Extractions, including surgical extractions of impacted teeth. (d) Necessary palliative treatment of dental pain. (e) Antibiotic medication. (f) Topical application of fluoride solutions. (g) Endodontics (root canal therapy). (h) Periodontal therapy to eliminate acute symptoms. (i) (j) (k) Provision of space-maintainers for missing primary teeth and provision of habit-breaking appliances. Consultations required by attending Dentist or Oral Surgeon. Surgical preparation of dental bridges for prosthetic appliances. 27

33 (l) Oral surgery and the provision of prosthetic appliances resulting from accidental injury to the jaw or natural teeth, provided that the treatment is performed and appliances supplied within 6 months of the accident, and subject to and part of the maximum in (2) below. (m) Diagnostic X-rays and laboratory procedures required in relation to oral surgery. (n) Anaesthesia. (2) The following services are covered up to a maximum of $2,000 per calendar year: (a) 80% of fees allowed for providing crowns, dental implants (not to exceed the cost of crowns), bridges and partial or complete dentures, including denture repair and replacement, except in the case of lost, mislaid or stolen dentures. (b) 80% of fees allowed for orthodontic treatment initiated for a child who is at least 6 years but less than 14 years of age at the time of the initial consultation with an Orthodontist. Alternate Benefit Clause When two or more covered dental procedures are separately suitable for the dental care of a specific condition, and both are consistent with good dental care, the Welfare Plan will provide benefits based on the least expensive service. Pre-Determination of Benefits It is recommended that a treatment plan, in the form of a report prepared by the Dentist, be submitted prior to commencement of treatment when the course of treatment is expected to cost more than $300. The Employee will be advised of the amount payable under this Welfare Plan, before the dental work begins. 28

34 The following are not covered: (1) Replacement of dentures that have been lost, mislaid or stolen. (2) Temporary dental services. (3) That portion of the expense of fixed bridgework in excess of the charge which would have been made if the replacement of teeth could have been accomplished by a partial denture. (4) Dental check-ups or screening requested by an employer, a school or government. (5) Oral hygiene instruction. (6) An examination by, or the services of, a Dentist if required solely for the use of a third party. (g) Member and Family Assistance Program (MFAP) From time to time everyone faces difficult or stressful events in their lives. Most of the time, we handle these personal challenges fairly well. Other times, personal problems can become large enough that they begin to interfere with our effectiveness, happiness or safety, both at work and at home. The Member and Family Assistance Program (MFAP) provides confidential, professional counselling for a broad range of personal and family problems as well as a full suite of additional health and wellness tools and services. While the program can be used for crisis intervention, the ideal time to use the program is before problems escalate or become unmanageable. The Member and Family Assistance Program is a pro-active option for helping you manage your personal health and happiness. What Services Are Available To Me? Your MFAP offers you and your eligible dependents short-term counselling in person, by phone or through the Internet at: 29

35 What Does My Program Offer? Your MFAP covers counselling, in addition to assessment and referral when required, for a full spectrum of personal difficulties including, but not limited to: work-related stress relationship and family problems separation/divorce/custody financial and legal difficulties alcohol and drug dependency gambling and other addictions eating disorders difficulties with children psychological disorders anger management sexual harassment and abuse bereavement aging parents child/elder care resources retirement planning In addition to psychological counselling, you and your family members also have access to an array of other health and wellness services including: Child and Eldercare Locator Services Legal Advisory Service Financial Counselling Nutritional Counselling Online e-learning Courses Self-Help Information Library Health Risk Assessment Caregiver Support How Does My Program Work? Call Human Solutions and they will assist you in setting up an appointment at a time and office location convenient to you. A Human Solutions counsellor will work with you to address your specific concerns and help you develop efficient and practical solutions. 30

36 Is The MFAP Confidential? Yes, the MFAP is a confidential service. Human Solutions counsellors are required by law to maintain the strictest confidentiality. No one who inquires about or receives services under this Plan will be identified to anyone without your written consent. Who Do I Contact? To arrange confidential service, call one of Human Solutions 24 X 7 toll free Client Service Centres at (English) or (French). Another way to reach Human Solutions is through their website After logging in, scroll down the list of services under the Member Services section on the upper left hand corner of the page, select Counselling and complete and submit the convenient request information. 4. GENERAL EXCLUSIONS The following expenses are not covered under the Welfare Plan: (1) Treatment which is paid in whole or in part by a Provincial Government Plan (for example: Physicians' fees in excess of the amount covered by the Provincial Plan). (2) Treatment received from a medical or dental department which is maintained by an employer, a mutual benefit association, labour union, trustee or similar type of group. (3) Services or supplies received in respect of sickness or injury which is the result of war, declared or undeclared, or the result of engaging in a riot or a criminal act. (4) Services and supplies received for cosmetic purposes, except in connection with an operation performed to correct deformities resulting from injury or congenital defects that interfere with function. 31

37 (5) Pregnancy tests, examinations, check-ups or certifications not performed as a consequence of existing symptoms of illness, examinations for the use of a third party. (6) Charges by Physicians, Dentists or Pharmacists for completing forms or providing information. (7) Examinations and tests performed for insurance, employment, drivers licenses or educational purposes. (8) Transportation costs to and from a hospital or other facility for therapy or treatment. (9) Accommodation in a facility other than a Hospital or Convalescent Hospital. 5. COORDINATION OF BENEFITS If you are an Employee or a pensioner covered under the Welfare Plan and your Spouse is a member of another group health plan, and you and/or your eligible dependent children are covered as dependents under that plan, claims must be submitted as follows: (1) A claim for your own expenses must first be submitted to the Elevator Welfare Plan. (2) A claim for your Spouse's expenses must first be submitted to your Spouse's plan. You are required to give the details of your Spouse s plan to the Plan Administrator, so be sure that you have completed a Coordination of Benefits form. (3) A claim for your dependent children's expenses must first be submitted to the plan of the parent having the earlier month and day of birth (e.g., if you were born in the month of January and your Spouse was born in the month of June, you would first claim against the Elevator Welfare Plan for the children's expenses). (4) If there are any unpaid expenses under (1), (2) or (3) above, you may submit a claim to the second plan for the balance of the claim. Note: The combined reimbursement under both plans cannot exceed the total expenses incurred. 32

38 6. GENERAL INFORMATION Hospital care to the Standard Ward level and services provided by a Physician are covered under each Provincial Government Medical Plan. Such plans also cover other services and you should consult your local Government authorities for information in this regard. The laws of Canada require that if a Provincial Government Medical Plan pays any portion of the medical services or procedures, a private plan, such as the Welfare Plan, cannot cover any portion of the fee for such procedure or service. Accordingly, no portion of the fees for services and procedures provided by health care specialists, such as chiropractors or podiatrists, are covered by the Welfare Plan if your Provincial Government Medical Plan has paid for, or reimbursed you for any portion of that fee. Once the Provincial Government Medical Plan ceases to pay any portion of the fee, the Welfare Plan may pay such benefits as are provided under the Plan up to the limits as set out. 7. PAY-DIRECT COVERAGE If your employment is terminated and you remain available for work in the Elevator Industry, all benefits - with the exception of Weekly Indemnity and Long Term Disability benefits - will remain in force for a maximum of 6 months at no cost to you. If at the end of this 6-month period you remain unemployed but you are available for work in the Elevator Industry, you may maintain the same benefits by sending Pay-Direct contributions to the Plan Administrator through your Local Union Office. You may continue to make Pay Direct contributions for 24 months. The Trustees review this rate annually and adjust it to reflect an appropriate cost to provide the benefits. The rate in effect as of January 1, 2010 is $ per month, plus applicable taxes. This monthly rate is subject to change. If you take an extended vacation longer than 30 days, all benefits with the exception of Weekly Indemnity and Long Term Disability benefits will remain in force for the first 30 days at no cost to you. You must apply for a No Break In Service arrangement (see Section 10) if you take an extended vacation longer than 30 days. 33

39 If you are granted a No Break In Service arrangement and you wish to maintain all benefits with the exception of Weekly Indemnity and Long Term Disability you may do so by sending Pay-Direct contributions at the Pay-Direct rate in effect at the time of self-payment, plus applicable taxes, to the Plan Administrator. You may wish to send post-dated cheques for the period of your No Break In Service arrangement. All Pay-Direct payments must be accompanied by the appropriate form which should be counter-signed by your Local Business Representative. The option to maintain your benefits under the Plan is dependent upon your being available for work in the Industry at all times. If you are eligible, the initial form regarding Pay-Direct coverage, together with your cheque/money order, must be received by the Plan Administrator prior to the end of the sixth month following the month in which lay-off occurs. A notice of your required Pay Direct payment will be sent by the Plan Administrator prior to this date. Payments for subsequent months must be received by the Plan Administrator by the 20 th of the month prior to the month of coverage. Failure to make any payment when due results in cancellation of the option to maintain coverage under the Plan. FOR EXAMPLE: If you are laid off in the month of April 2009 and remain available for work in the Industry, you will be entitled to Welfare Plan benefits for the months of April 2009 to September 2009 at no additional cost. In order to have your Welfare Plan benefits continue for the month of October 2009 and thereafter, you must remain available for work in the Industry. The Plan Administrator will advise you in advance that a self payment is required and Pay-Direct payment must reach the office of the Plan Administrator by the 20 th of the month prior to the month of coverage in order to continue your benefit eligibility. Cheques or money orders should be made payable to the: "Canadian Elevator Industry Welfare Plan" 34

40 If, after you have made your payment to maintain your benefits, you are again employed by a Contributing Employer, you will receive a refund of the payment covering the period during which you were employed. You should submit proof of payment to the Plan Administrator in order to receive this refund. If you are unable to work due to a job related injury, all benefits - with the exception of Weekly Indemnity benefits - remain in force while receiving WCB/WSIB benefits until you recover and are available for work. If there is no work available at the time you recover, you are eligible to apply for 6 months of free coverage provided that you apply by the end of the month immediately following the month in which you recover. After this 6-month period, you may maintain your benefits for an additional twenty-four months by sending Pay Direct contributions to the Plan Administrator. Your Pay-Direct contribution must accompany the appropriate form and will apply to the month immediately following the month in which free coverage ceases. 8. EXTENSION OF MAJOR MEDICAL AND DENTAL BENEFITS ON AN EMPLOYEE S DEATH If you die while an active Employee, your eligible dependents will continue to be covered for Major Medical and Dental Benefits for 6 months at no cost. At the end of 6 months, continuation of such benefits, subject to some restrictions, will be available at the currently set cost of $50 per month, plus applicable taxes. This rate is reviewed from time to time by the Board of Trustees and may change in the future. Payments for coverage must be received by the Plan Administrator prior to the end of the month for which they are due and failure to make any payment when due will result in cancellation of this optional coverage. 9. EXTENSION OF MAJOR MEDICAL AND DENTAL BENEFITS IF SICK OR DISABLED If you are in receipt of Employment Insurance Sickness/Accident benefits, Weekly Indemnity benefits, Long Term Disability benefits, or Workers Compensation benefits, Major Medical and Dental benefits will continue for you and your eligible dependents. If you receive a Workers Compensation settlement, you must either apply for and be granted Weekly Indemnity or Long Term Disability benefits, or return to work if able. 35

41 If you die while your benefits are continuing, your eligible dependents will continue to be covered for Major Medical and Dental Benefits as described above in Section 8. If you are in receipt of Employment Insurance Sickness/Accident benefits or Workers Compensation benefits, you must provide the Plan Administrator with proof of sickness or disability by forwarding a copy of your first cheque stub. Similar proof of sickness or disability will be required on an annual basis. Upon receipt of the copies of your cheque stub, you will be credited with service in the Pension Plan of 32 hours per week for the duration of your disability until the date when you are eligible for an Unreduced Early Retirement Pension. 10. NO BREAK IN SERVICE ARRANGEMENT A "No Break in Service" is an arrangement that may be granted under the Pension Plan by the Trustees following a leave of absence approved by your Employer and the International Union of Elevator Constructors. Your coverage under the Welfare Plan continues up to the date that contributions on your behalf cease. If you are granted a No Break in Service arrangement by the Trustees for any reason other than for an extended vacation or maternity/parental leave, you are not entitled to maintain your coverage under the Welfare Plan for the period of such arrangement. If you are granted a No Break in Service for an extended vacation, you may make Pay-Direct contributions to the Plan at the Pay-Direct rate in effect at the time of self-payment, plus applicable taxes. If you are on an extended vacation and have not applied for or have not been granted a No Break in Service arrangement, you are not eligible to make Pay-Direct contributions and cannot maintain your coverage under the Welfare Plan. If you are granted a No Break in Service for a maternity/parental leave, you will be provided six months of free Welfare coverage. If you wish to extend your leave up to an additional six months, you must reapply for a No Break in Service. If you are granted a No Break in Service for this extension, you may make Pay-Direct contributions to the Plan at the Pay-Direct rate in effect at the time of self-payment, plus applicable taxes. 36

42 11. DESIGNATION OF BENEFICIARY You may name any person you wish, or your estate, as your beneficiary. It is extremely important that you name a beneficiary to receive the Life Insurance benefit due under the Plan in the event of your death. The beneficiary should be named on your Member Information Card and any subsequent changes submitted to the Local Union Office. To ensure that your beneficiary designation is up to date, you must complete and return the Welfare Member Information Change Form and/or the Pension Member Information Card immediately. These forms can be obtained from the Plan Administrator or from your Local Union Office. 12. BENEFITS PERTAINING TO PENSIONERS (a) Eligibility of Pensioners for Welfare Plan Benefits After Retirement To be entitled to Welfare Plan benefits at retirement you must have completed 3 years of Continuous Service within the 10-year period immediately prior to retirement and a total of 20 years participation in the Plan. If you do not qualify for Welfare Plan benefits under this provision, and you are retiring from active employment in the Elevator Industry, your Spouse, designated beneficiary or estate will be entitled to a $10,000 Death Benefit on your death. (b) Welfare Plan Benefits After Retirement If you retire from active employment in the Elevator Industry on or after you reach age 50 and you meet the requirement in (a) above, you and your dependents will be covered only for Major Medical and Dental benefits. These benefits will be the same as they were while you were an active Employee. Currently, if your monthly pension is less than $2,000 you will be required to contribute $85 per month, plus applicable taxes, towards the cost of these benefits. If your monthly pension is $2,000 or more you will be required to contribute $100 per month, plus applicable taxes, towards the cost of these benefits. 37

43 If you die after retirement, your eligible dependents will be covered for the same Major Medical and Dental benefits as prior to your death, by contributing the monthly amount shown above based on the monthly pension amount, plus applicable taxes. Your designated beneficiary or Estate will be entitled to a Death Benefit of $10,000 upon your death. (c) Welfare Plan Benefits on Disability Retirement Notwithstanding (a) above, if you are in receipt of a Disability Retirement Pension, your coverage for all Welfare Plan benefits, except AD&D benefits, Weekly Indemnity benefits and Long Term Disability benefits, will continue by contributing $85 per month, plus applicable taxes. From the date of your disability retirement until age 65, if you die, your nominated beneficiary or Estate will be entitled to a Life Insurance benefit and a Death Benefit of $10,000. The amount of the Life Insurance benefit depends upon the date on which you became eligible for a Disability Retirement Pension. If you die after age 65, only the Death Benefit of $10,000 is payable. If you die after the date of your disability retirement, your widow(er) and dependents will be covered for the same Major Medical and Dental Benefits as prior to your death by contributing $85 per month, plus applicable taxes. (d) Employees Who Retire From Active Employment in the Elevator Industry and Do Not Qualify For Welfare Plan Benefits Under Paragraph (a) Above If you have not completed 3 years of Continuous Service within the 10 year period immediately prior to retirement and a total of 20 years participation in the Plan at retirement, you will not qualify for Welfare Plan benefits, as explained in (a) above. However, even though you do not qualify under (a) above, if you are retiring from active employment in the Elevator Industry and are a participating member of the Plan at retirement, you may continue your coverage until your death for all benefits except Life Insurance, AD&D benefits, Weekly Indemnity benefits, and Long Term Disability benefits by contributing $110 per month, plus applicable taxes, if your monthly pension is less than $2,000. If your monthly pension is $2,000 or more you will be required to contribute $125 per month, plus applicable taxes, to continue your coverage until your death for all benefits except Life Insurance, AD&D benefits, Weekly Indemnity benefits and Long Term Disability benefits. 38

44 If you have elected to continue your Welfare Plan benefits after retirement and you die after retirement, your widow(er) can continue for the rest of her/his life (some restrictions such as remarriage, etc. may apply) the same Major Medical and Dental benefits as prior to your death by contributing the monthly amount shown above based on your monthly pension at the time of your death, plus applicable taxes. (e) Continuation of Welfare Plan Benefits After Retirement In order to be entitled to receive Welfare Plan benefits, you must maintain your membership in good standing of the applicable Local Union of the International Union of Elevator Constructors. If you retire from active employment and are no longer within the scope of the Collective Agreements and are in receipt of a pension from the Pension Plan, you will be entitled to receive the Welfare Plan benefits as stipulated in this booklet. However, if you return to employment in the Elevator Industry and work for an Employer who is not bound by one of the Collective Agreements, all Welfare Plan benefits shall immediately cease. If you are less than 65 years of age and decide to return to employment with any participating Employer or any entity which is related to, or affiliated with that participating Employer, whether in Covered Employment or employment which is not covered under a Collective Agreement within 6 months of the payment of the first instalment of your pension benefit, your retirement will be deemed not to be bona fide, your pension will be cancelled and you will not receive any further pension benefit payments while you remain in such employment. If you are expelled from a Local Union of the International Union of Elevator Constructors, any entitlement to Welfare Plan benefits shall immediately cease. 13. TERMINATED FORMER EMPLOYEES Welfare Plan benefits are not payable to a former Employee entitled to a vested deferred pension under the Pension Plan and whose deferred pension benefit becomes payable under the Pension Plan. 39

45 14. HOW TO SUBMIT CLAIMS (a) (b) (c) Obtain the appropriate claim form from your Employer, Local Union Office or the Plan Administrator. Complete the form in accordance with the instructions shown at the top of each form. Medical and Dental Claims 1. Have your doctor or dentist complete any statement required to support your claim. In the case of a dental claim the Dental Association procedure code must be given on the form in order for the claim to be processed. Dental claims without such codes will be returned to the member so the dental code can be obtained from the dentist. 2. Attach to your form, receipts for payment of the services or supplies provided. 3. Claims will be paid only for services rendered; no payment can be made towards planned treatment. 4. If your dentist accepts assignment of your benefits payable, you must sign the appropriate section of the Standard Dental Claim form. The Plan Administrator will then forward payment directly to your dentist. 5. Claims must be submitted promptly, in any event, not later than December 31 of the year following the year in which expenses are incurred. 6. Electronic Filing of Dental Claims If your Dentist has access to Electronic Filing of Dental Claims, provide your Dentist with the policy number shown on your Certificate Card to verify that the Plan Administrator does accept electronic filing of dental claims. Once your Dentist Office submits your claim to the Plan Administrator, the system will automatically verify eligibility and coverage amounts and will expedite reimbursement to you or your Dentist, if applicable. 40

46 (d) Disability Claims 1. For Weekly Indemnity benefits, all claims must be submitted to the Plan Administrator within 45 days of the date benefits are due to commence. Please ensure all portions of the claim forms are fully completed and signed. Your Local Union Business Representative must also complete part of this form. 2. For Long Term Disability benefits, all claims must be submitted to the Plan Administrator within 6 months of the date benefits are due to commence. Please ensure all parts of the claim form are fully completed and signed. Please note: It is important you apply for Long Term Disability benefits whether or not you are in receipt of any Workers Compensation benefits. (e) All claims must be submitted directly to the Plan Administrator: Manion, Wilkins & Associates Ltd. Claims Department Four Seasons Place Etobicoke, Ontario M9B 0A6 Contact Centre Telephone: Toll Free: Fax: [email protected] Website: Website: ceiwpp.ca If you are not sure of your rights or benefits under the Plan, please communicate in writing with Manion, Wilkins & Associates Ltd. 41

47 15. TERMINATION OF WELFARE COVERAGE If any person wilfully makes a false statement material to a claim for Plan benefits, or fails to disclose receipt of any income which would result in the reduction of such benefits or require the repayment of such benefits, the Trustees shall have the right to adjust any future payments to recover all payments made to the recipient who was not entitled to such payments, or take any other steps they determine advisable including terminating the coverage of the person who made such false statement or failure to disclose. 16. FUTURE OF THE PLAN The Contributing Employers and the International Union of Elevator Constructors expect and intend to keep the Plan in force indefinitely. However, the Trustees may change or modify the Plan from time to time. If the Plan is discontinued, all moneys in the Trust Fund must first be used for the benefit of Employees and their beneficiaries, and distribution will be made according to the terms of the Welfare Plan. The Boards of Trustees in their sole discretion have the authority to amend, suspend, delete, or terminate any benefit provided under the Welfare Plan, subject to applicable government regulations. Any particular benefit payable at any particular time does not guarantee that such benefit will be provided for any specific period of time. Any postretirement benefits or benefits payable to disabled members may be amended, suspended, deleted, or terminated at any time by the Boards of Trustees in their sole discretion. 42

48 1. RETIREMENT DATES PENSION PLAN (a) Normal Retirement Age Normal Retirement Age is age 65. (b) Early Retirement Early Retirement is permitted if you have attained age 50. However, if you have attained age 60 you may retire at any time without reduction to the amount of benefit standing to your credit, provided that you are retiring from active employment in the Elevator Industry, and have completed 20 years of continuous Credited Service immediately before retirement. (c) Postponed Retirement You are permitted to retire after your Normal Retirement Date but not later than the end of the year in which you attain age CREDITED SERVICE The amount of your pension depends on your Credited Service which is determined as follows: (a) Credited Past Service (service before October 1, 1962) If you were eligible for employment within the terms of the Canadian Standard Agreement when the Plan was established and you were active on September 30, 1978, you receive credit for service from the date of your last initiation into the International Union of Elevator Constructors up to October 1, (b) Credited Future Service (service after October 1, 1962) You receive credit for each hour you work after October 1, 1962 for which contributions are made to the Plan on your behalf. 43

49 If you are in receipt of Workers Compensation benefits, Weekly Indemnity, Long Term Disability, Employment Insurance sickness or disability benefits, or Canada/Quebec Pension Plan Disability benefits, you will be credited with service of 32 hours per week. Note: All references to "years of Credited Service" refer to continuous years from the date of your last enrolment in the Plan as a participating member to the relevant date, e.g. your date of retirement. If your Credited Service is not continuous due to a Break in Service (see Section 7), your entitlements under the Plan may be affected. 3. AMOUNT OF PENSION (a) Normal Retirement or Postponed Retirement Your annual pension payable will be made up as follows: (1) $67.00 multiplied by your years of Credited Past Service, plus (2) $67.00 for each 100 hours of Credited Future Service. (b) Early Retirement For you to retire before age 65 and receive an unreduced pension, the Trustees must first approve the payment of unreduced pensions. The Trustees annually review the financial status of the Plan to see if it is in a position to allow unreduced early retirement. If it is not, all members will be notified in advance. (1) Early Retirement Pension If you retire after attaining age 50, your Early Retirement Pension will be the annual pension earned to your date of retirement reduced by 1/2 of 1% for each calendar month between your Early Retirement Date and age

50 (2) Unreduced Early Retirement Pension If you retire at age 60 or later and after completing at least 20 years of continuous Credited Service in the Elevator Industry immediately before retirement, your Unreduced Early Retirement Pension will be equal to the annual pension earned to the date of retirement without reduction, provided the funding of the Plan is adequate to allow for this benefit. (c) Effect of Break in Service on Retirement If you suffer a Break in Service (see Section 7), you must accumulate the required years of Credited Service from the date of your return to work in order to receive a pension based on the current formula. 4. PENSION BENEFITS AT OR AFTER DEATH OF A RETIRED MEMBER If you retire on or after August 1, 1992 from active employment in the Elevator Industry and do not have a Spouse at the time of your retirement, and you die within the 10 year period after your retirement date, pension payments will continue on your death at 100% for the balance of the 10 year period to your designated beneficiary or estate. If you retire on or after August 1, 1992 from active employment in the Elevator Industry and you have a Spouse at the time of your retirement, and you die within the 5 year period after your retirement date, pension payments will continue on your death at 100% for the balance of the 5 year period to your Spouse, or your designated beneficiary if your Spouse predeceases you. Thereafter, your Spouse at the time of your retirement will be entitled to receive a Survivor Pension for his or her lifetime equal to 66 2/3% of your retirement pension. Alternatively, if you have a Spouse at the time of your retirement, you may elect to have your pension payments continue on your death at 100% for the balance of a 10 year period, after your retirement date, to your Spouse, or your designated beneficiary if your Spouse predeceases you. After the 10-year period, your Spouse at the time of your retirement will receive a Survivor Pension equal to 66 2/3% of your retirement pension. If you elect the 10 year guarantee, the initial amount of pension payable to you on retirement will be payable on a reduced basis. 45

51 5. ADDITIONAL SUPPLEMENTARY BENEFIT Provided the funding of the Plan is adequate you will be entitled to an additional supplementary benefit of $400 per month if you have attained 55 years of age and are retiring early from active employment in the Elevator Industry with 20 or more years of continuous Credited Service immediately before retirement. The benefit will be paid on a monthly basis from the effective date of your pension and cease on the first day of the month following your 65 th birthday or with your death (whichever occurs first). If you have a Spouse when you retire and you die prior to reaching age 65, your Spouse at the time of your retirement will be entitled to receive an additional supplementary benefit equal to 66 2/3% of your additional supplementary benefit, payable until the first day of the month following when you would have attained age 65, or until his or her death (whichever occurs first). This additional supplementary benefit will not be used in the calculation of any benefit paid on termination of membership or in the calculation of any pre-retirement death or survivor benefit. 6. APPLICATION FOR, AND PAYMENT OF, PENSIONS When your retirement date approaches you should obtain an Application for Retirement Pension form from your Local Union Office and complete it as required. This Application form must be in the hands of the Plan Administrator prior to the date on which you wish your pension to commence. Your application form must be accompanied by satisfactory proof of your age (see Section 13 (f)) and of the age of your Spouse. Pension payments will normally start on the first day of the month after your retirement date, provided that your Application form has been received by the Plan Administrator at that time. If the annual amount of pension payable is less than 2% of the Year's Maximum Pensionable Earnings under the Canada Pension Plan in the year of retirement, payments may be made quarterly, semi-annually or annually, or may be paid in a lump sum. In the event that you become incapable of managing your affairs as a result of physical or mental illness, the Trustees may direct that payments be held until a guardian, committee or other legal representative is appointed. 46

52 7. BREAK IN SERVICE A Break in Service occurs if you do not make yourself available for Covered Employment under the terms of the Collective Agreement for a period of three or more consecutive months. If you suffer a Break in Service, you will be entitled to the Termination Benefits as set out in Section 10 depending on your age and years of Credited Service. If you later return to work in Covered Employment, you will be treated as a new Employee and must re-enrol in the Plan. Credited Service will then accumulate from the date of your return to work. If you had a Break in Service and previously elected not to transfer the commuted value of your accrued pension out of the Plan and later return to work in covered employment, your deferred pension earned prior to the Break in Service will be recalculated at the current benefit rate after you complete five years of continuous Credited Service after your return to work. Absence for any of the following reasons will not count as a Break in Service: (a) (b) (c) (d) (e) unemployment, provided that you have made yourself available for Covered Employment under the terms of the Collective Agreement; temporary total disability, provided that satisfactory medical evidence of your disability has been submitted to the Trustees; leave of absence which has been approved by your Employer, the International Union of Elevator Constructors and the Trustees (see No Break in Service below); service with the International Union of Elevator Constructors in an elected or appointed position; military service in the Armed Forces of Canada, subject to the following limitations: (1) military service is during a period of national emergency, (2) you do not re-enlist after the time you would have been discharged, (3) you apply for work in the Elevator Industry within 90 days after your discharge. 47

53 8. NO BREAK IN SERVICE ARRANGEMENT If you are granted a leave of absence or an extended vacation by your Employer and the International Union of Elevator Constructors, and contributions to the Plan on your behalf have ceased, you must protect your position in the Plan by applying to the Trustees for a No Break in Service arrangement stating the reasons for your absence. If such arrangement is granted, you will not lose any benefits earned up to the date of your leave of absence or extended vacation. When the period of your No Break in Service arrangement is over, you must immediately make yourself available for work with a Contributing Employer, otherwise you will be treated as having terminated your employment. If you do not apply for a No Break in Service arrangement and you take a leave of absence or extended vacation, you will suffer a Break in Service and will be treated as having terminated your employment. In this case your pension benefits will be subject to the rules relating to termination of membership in the Plan set out in Section 10. If you subsequently return to work, you will be treated under the Plan as a new Employee. 9. DEATH BENEFITS BEFORE RETIREMENT If you die prior to retiring, your Spouse will receive either a lump sum amount equal to the commuted value of your pension accrued to the date of your death, or an immediate or deferred pension equal in value to this lump sum. If you do not have a Spouse at the time of death, your designated beneficiary or estate will receive this lump sum amount. If you die before age 55, the commuted value of your pension earned for service after December 31, 2000 will be adjusted to include 50% of the change in the Consumer Price Index, to a maximum of 2% per year, from your date of death to age 55. In addition, if you die while actively employed in the Industry and after having completed five years of Credited Service, or while in receipt of a Disability Pension but before your Normal Retirement date under the Plan, each of your dependent children under 18 years of age will receive $100 per month commencing on the first day of the month following your death. This benefit will be paid to the child's legal guardian and will cease with his/her 18th birthday. 48

54 10. TERMINATION BENEFITS You are entitled to termination benefits if you have a Break in Service. You may elect termination benefits if contributions have not been made on your behalf for 24 months or more. If you are entitled to termination benefits, your benefits are locked in. You will be provided with a deferred pension, in an amount equal to the pension earned to the date of your termination, which is payable at your Normal Retirement Date. If you have not yet reached age 55, the pension earned for service after December 31, 2000 will be adjusted to include 50% of the change in the Consumer Price Index, to a maximum of 2% per year, from your date of termination to age 55. You may transfer the commuted value of your accrued pension at your termination date to the registered pension plan ("RPP") of your next employer, if that plan so permits, or to a locked-in registered retirement savings plan ("RRSP") to provide you with a pension at retirement, or to a life income fund ( LIF ), or to a locked-in retirement account, or have a deferred life annuity purchased which would be payable at any time after age 50. If you wish to have the commuted value of your accrued pension transferred to a locked-in RRSP, LIF, LRIF, or RPP of your next employer, you must provide satisfactory proof of age (see Section 13 (f)) and sign a locking-in agreement in the form required by the Trustees when applying for such transfer. Upon completion of this transfer, no further benefits are payable under the Plan. If you have reached age 55, you may not transfer your benefit entitlement out of the Plan. You are entitled to a pension at age 65 equal to your pension benefit accrued to your date of termination. You may elect to receive such pension as early as age 50. However, your accrued pension benefit will be reduced by 1/2 of 1% per month for each month you retire prior to the date on which you would have reached age 65. If you are entitled to a deferred pension payable by the Plan, having previously terminated your employment in the Industry, and you die before you have applied to have your pension payments commence, your designated beneficiary or estate will receive a lump sum amount equal to the commuted value of your deferred vested pension accrued to the date of your death. 49

55 11. EMPLOYMENT OF A PENSIONER If you are receiving a pension from the Plan and you return to work for an Employer who is participating in the Plan, your pension benefits will be suspended. You are required to advise the Trustees, immediately upon employment, that you have returned to work. Your monthly pension payments will be suspended during this period of employment after retirement. The amount of monthly pension payable after such a period of employment is equal to the amount you were receiving before your pension was suspended plus an adjustment to reflect any additional pension which you have earned based on hours reported and contributions made to the Plan for this period of employment after retirement. The additional pension payable for this period of employment will be calculated in the same form of pension you selected upon your initial retirement. If you are receiving a pension from the Plan and you return to work before age 65, but within 6 months of your retirement date, for any participating Employer prior to your retirement or for any employer related to or affiliated to any Employer, your retirement will be cancelled. No further pension payments will be made while you continue in this employment. If your pension is cancelled because your retirement is not bona fide, you will be required to repay any pension benefit payments made to you. 12. DESIGNATION OF BENEFICIARY If you do not have a Spouse, or are living separate and apart from your Spouse, you may name any person you wish as your beneficiary, or you may designate your estate, to receive any benefits due under the Plan in the event of your death. If you have a Spouse, your Spouse will receive any benefits due under the Plan in the event of your death. In the province of Ontario an Employee and the Spouse may waive this requirement in which case the Employee may name any person or his or her Estate to receive any benefits due under the Plan in the event of his or her death. 50

56 13. GENERAL PROVISIONS (a) Pension Trust Fund Contributions by Employees and Employers are paid regularly into a trust fund held by a corporate trustee and invested in accordance with the requirements of the Pension Benefits Acts. Benefits from the Plan will be paid out of this fund either in cash or by means of pensions provided through the fund. (b) Members' Annual Pension Statements During the year you will receive a statement effective as of December 31 of the previous year showing your hours worked for which contributions have been made to the Plan, your annual pension earned to the statement date and payable from your Normal Retirement Date, your own contributions to the Plan with and without interest and other required information. (c) Assignment of Benefits The purpose of the Plan is to provide you with an income after you retire. For this reason you may not assign any of its benefits other than by naming a beneficiary or joint annuitant. The Plan does not confer on an Employee any right or interest in the benefits and the benefits cannot be surrendered except as provided in the Plan. (d) Future of the Plan The Contributing Employers and the International Union of Elevator Constructors expect and intend to keep the Plan in force indefinitely. However, the Trustees may change or modify the Plan from time to time. If the Plan is discontinued, all moneys in the Trust Fund, after providing for the expense of the Plan, must be used for the benefit of Employees and their beneficiaries. Distribution will be made according to the terms of the Plan consistent with the Pension Benefits Act. 51

57 The Boards of Trustees in their sole discretion have the authority to suspend, delete, or terminate any benefit provided under the Welfare Plan and the Pension Plan, subject to applicable government regulations. Any particular benefit payable at any particular time does not guarantee that such benefit will be provided for any specific period of time. Any post-retirement benefits or benefits payable to disabled members may be suspended, deleted, or terminated at any time by the Boards of Trustees in their sole discretion. (e) Gender and Number Unless the context otherwise requires, words in the singular shall be construed as including words in the plural and words in the plural as including words in the singular and words importing the masculine gender shall be construed as including the feminine. (f) Documents Considered As Proof of Age The best proof of age is a birth certificate or baptismal certificate. If one is not available, then any two of the following pieces of identification can be used: (a) (b) (c) (d) (e) Immigration papers Marriage licence Citizenship papers Passport Driver s licence 14. TERMINATION OF PENSION COVERAGE If any person wilfully makes a false statement material to a claim for Plan benefits, or fails to disclose receipt of any income which would result in the reduction of such benefits or require the repayment of such benefits, the Trustees shall have the right to adjust any future payments to recover all payments made to the recipient who was not entitled to such payments, or take any other steps they determine advisable including terminating the coverage of the person who made such false statement or failure to disclose. 52

58 - Member Information Card APPENDIX A WELFARE PLAN - FORMS - Member Information Change Form - Claim Form for Extended Health Care, Prescription Drugs, and Vision Care Benefits - Standard Dental Claim Form - Weekly Indemnity Claim Forms - Long Term Disability Forms - Death Claim Form - Pay Direct Contributions/Disability Notification Note: Available on the Website ( at Plan Administrator s Office, or your Local Union Office. 53

59 - Member Information Card - Request for Information APPENDIX B PENSION PLAN - FORMS - Application for Pension Benefits - Instructions for Completion - Canadian Elevator Industry Retirement Form for Employees Less Than 65 Years of Age (Declaration and Acknowledgement Form) - Retired Member Returning to Covered Work Age 65 or Older (Consent and Acknowledgement Form) - Request For No Break In Service Note: Available on the Website ( at Plan Administrator s Office, or your Local Union Office. 54